This week, I’m traveling to Los Angeles for a round table discussion with a small group of wildly successful people who all have one thing in common: we were medicated with psychiatric drugs when we were kids.

We connected through a private WhatsApp chat hosted by a megawatt podcaster. Around 800 of us are in the group, all of whom have either guested or will be guesting on this podcast (my episode should be released by the end of the year.) Amid the usual chatter about sales funnels and product launches, the conversation turned to medicating kids. Multiple people chimed in about how a childhood spent on Adderal, benzos, and antidepressants derailed the first third of their lives and led to addiction, psych wards, and prison.

Though all of us are lucky to have come through it, one person put it best:

“After years of struggle, I’ve finally overcome the battle but not without an immense cost to my sanity, family, and friends.”

All of us were minors when we were medicated, so all of our parents signed off on the treatment. I can’t speak for anyone else’s parents, but my mom maintains that had she known what she knows now, she would have at least gotten a second and third opinion before filling my scripts.

Though most of my focus is on psych drug withdrawal and how to find yourself in the aftermath of long-term psych drug use, I always hope my work makes people think twice about starting a psychiatric drug in the first place. And I especially hope it stops parents from drugging their kids just because it’s the easy way out and every other parent is doing it. The costs of this choice are incalculable. I cannot overstress that there is zero scientific backing or research exploring the effects of psychiatric drugs on developing minds and bodies. To drug your kid with stimulants, antidepressants, or antianxiety drugs takes away their agency, turns them into an experiment, and can irrevocably change their system and perception of the world for the rest of their life.

And if you don’t believe me, maybe the work of Robert Whitaker, a Pulitzer prize finalist, or Dr. David Healy, former Secretary of the British Association for Psychopharmacology can sway you.

With that, here are five books I think every parent should read before medicating their kid or taking their kid to a psychiatrist.

Share widely.

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By Robert Whitaker

There is an uncomfortable question in the world of mental health and treatment that everyone thinks about, but no one says out loud: If medicating mental illness with psychiatric drugs was working, why are people getting worse?

This book examines over fifty years of research to find the answer and comes to a startling conclusion. I think it is the single most comprehensive and explanatory book on the market about the true nature and outcomes of psychiatric drugs and that it should be required reading in all medical schools.

It is also divided into multiple diagnoses (schizophrenia, bipolar, depression, and ADHD), which I found particularly useful as someone who focuses mostly on the history and treatment of depression.

By Ethan Watters

To understand why mental illness has such a strong pull in American culture, it is important to understand how mental illness is created in the first place. Yes, created.

When I was depressed and taking antidepressants, I thought my depression was caused by a chemical imbalance and that it was just who I was. After all, that’s what the doctors told me. We now know the chemical imbalance theory is unsubstantiated, and yet the narrative remains.

Watters’ book blew my mind by showing exactly how the false chemical imbalance theory was exported all over the world and why this has fundamentally affected recovery rates—for the worse—all over the globe. 

By David Healy

Though this is technically an academic book, it is extremely readable and the best account of the manipulative marketing, hidden court cases, and corruption that occurred during the development of Prozac and Zoloft.

It’s one of those books where, if my mother or I had read it before I was medicated at 15, I’m quite sure we would not have made the same choices. 

By Ben Goldacre

A book about pharmaceutical corruption and manipulative science can rarely make me laugh out loud, but Bad Science does just that.

Not only did the book make me a better advocate for my health by teaching me what red flags to look out for in research and shady science journalism, but it kept me consistently entertained to the point where I was disappointed when the book ended. It should be required reading in all high school science classes. 

By Abigail Shrier

It took me a long time to understand how my mother’s well-intentioned decision to send me to a child psychologist derailed my whole life, but Bad Therapy finally put the pieces together. In being diagnosed with depression and anxiety as a teen—and consequently medicated for it—a message was sent by the adults around me: I did not have the capacity to help myself.  

That unspoken message haunted me for the next fifteen years, leading me down a path of self-induced victimhood, fragility, and, paradoxically, more depression. I see this happening with an entire generation, and this book explains why—a must-read for every parent or medicated kid. 

In the eight years (!) since my last antidepressant, the majority of my free time has been dedicated to healing and supporting my physical and emotional body. Though the majority of the Happiness Is A Skill archive focuses on psycho-emotional tools and philosophy, most of my day to day work is rooted in the physical.

The marketing around mental and physical health focuses on things companies can sell to consumers: supplements, diets and specific manufactured foods for that diet, and pharmaceutical drugs. This leads people to think that some random supplement, the keto diet, or a new drug will be the answer. Sometimes, these things help. But more often than not, it’s a futile experiment that results in wasted money at best and iatrogenic harm from misprescribed pharmaceuticals at worst.

This isn’t to say that physical interventions don’t matter. They absolutely do—and we’ll get to what I’m experimenting with these days—but people have it backward. They think if they get the physical nailed down, the psycho-emotional mind will follow. Instead, they end up building a backward, ineffective pyramid of healing that teeters on an unsupported base:

Here’s how this plays out:

Someone is having a rough time. Maybe they have their basic physiological needs covered, maybe they don’t. Let’s assume they do, because not having your basic needs covered is a different issue.

Instead of looking at their actions or their life situation, this person throws a bunch of money at some random wellness trend, hack, or drug. When that doesn’t work, maybe they try a new diet or sign up for an exercise class. But because the root issues haven’t been addressed, they can’t stick to those changes. At this point, whatever issue is going on in someone’s life is likely intensifying. Basic needs, whether financial, interpersonal, or health-related, are likely starting to crack. This is scary enough that maybe they try therapy, but there’s no foundation to support it, so it doesn’t “work,” leading to more destruction that will eventually topple the whole thing over.

In reality, the mind leads and the body follows. It’s as if you are tending a garden and strategizing the best way to grow a bounty. Sure, you can plant healthy seeds in parched, malnourished soil. Something will grow (maybe), but it’s not going to thrive. Or, you can take the time to regenerate the soil—which means a fallow harvest while the soil is healing—knowing next year’s crops will be set up to thrive.

This pyramid plays out in a different way:

This person has their basic psychological needs covered. It may not be the highest quality food, shelter, or security, but there’s enough of it to put focus elsewhere. Instead of scattering their energy across unsubstantiated wellness trends, they commit to emotional work. This could be through formal therapy, meditation, inner child work, hypnotherapy, spiritual counseling—whatever, as long as it resonates and doesn’t result in a bullshit DSM label/diagnosis. As the emotional work settles in, avenues of physical change emerge. It becomes easier to eat the way the body needs, because the desire to self destruct or self-soothe with food is lessened. When the body gets the right nutrients, sleep improves. When sleep improves, energy goes up and exercise is more sustainable. Now, this person has a frame of reference for how shitty they felt and how much better they feel. They are motivated to keep it up, to hone in on specifics, and get nerdy with it. They have earned the right to tinker with supplement stacks because, as one of my mentors once put it, “They are no longer eating, sleeping, and thinking like an asshole.”

I say all this because, inevitably, someone is going to read this issue, cherry pick a few things, and bitch when it doesn’t work. I’ll ask them about their diet or what action they’re taking in their emotional life, and they’ll tell me they’re eating lots of low fat muffins and haven’t fired their therapist, even though they haven’t made progress in years.

If that’s you, then you’re doing it wrong. Feel free to follow what calls to you and make many changes at once, but know that without the right base, it’s unlikely anything else will have a major impact.

With that said, I know so many of you are ready to level up. So here are all the things I’ve been experimenting with in 2024 to support my physical health.

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My foray into fixing my physical health after 15 years of antidepressants began in 2021 under the eye of an old friend and human performance expert Andy Galpin, PhD, and performance bloodwork specialist Dan Garner. Andy and Dan were quietly working with professional athletes, using biomarkers from an extensive series of lab tests to hone in and eradicate issues. After getting nowhere with traditional doctors, I reached out to Andy and Dan and they took me through their program.

Andy and Dan have now exploded in the performance space. Their R.A.P.I.D. program is the gold standard, but it is financially prohibitive for those of us who aren’t on multi-million dollar contracts.

To reach more of us normal folk, Andy and Dan created Vitality Blueprint, one of the world’s most in-depth blood tests on the market. Vitality’s bloodwork system measures over 100 biomarkers (your standard bloodwork from a doctor only measures 10), analyzes over 20,000 biomarker calculations, and breaks down the results into 13 categories including micronutrients, hormone profile, sleep, toxic load, and gut health.

Furthermore, results come with personalized programs that explain exactly how to eat, what lifestyle changes to make, and what supplements to take that will enhance and repair your unique physiology.

It’s not covered by insurance, but it’s no more expensive than throwing out hundreds of dollars a month on supplements you don’t need. And as a longtime supporter of Dan and Andy’s work, they have graciously offered HIAS subscribers 10% off any of their programs using the code VITALITYSIEM. I highly, highly recommend it.

Not to be confused with a carnivore diet, which is based exclusively on meat, or a ketogenic diet which severely restricts carbohydrates and relies on fat as fuel, the animal-based diet consists primarily of high-quality meat, organs, fruit (and fruits mistaken as vegetables), honey, raw dairy (if tolerated) and eggs.

A typical day for me includes:

Breakfast: coffee with collagen and coconut milk, 3 eggs fried in raw butter and 3 medjool dates with macadamia nut or raw almond butter.

Lunch: some sort of grass-fed/organic/pasture-raised protein (beef, bison, or chicken), some sort of fat like full-fat kefir or yogurt, raw cheese, or nuts, and carbohydrates from fruits like berries, citrus, apples, and dried mango.

Dinner: some sort of grass-fed/organic/pasture-raised protein or wild fish, light greens or a fruit masking as a vegetable (cucumbers, peppers, tomatoes, squash, etc—anything with seeds), fat from avocados, raw butter, or macadamia nut oil, and carbohydrates from sweet potatoes or white rice. Occasionally, I’ll incorporate vegetables I know I can tolerate like light greens (arugula, spring mix), broccoli, cabbage, or green beans. Most days, I have some high-quality dark chocolate for dessert.

I rarely snack, but if I do, it’s nuts and fruit, minimally processed meat sticks or jerky, or some whey protein.

I avoid seed oils (canola, safflower, grapeseed, peanut, etc.), anything fried, alcohol, gluten, grains, white sugar, beans, and most vegetables.

This diet has taken me years to dial in, but now it’s so second nature that I don’t even think about it. My bloodwork is pristine and my body composition remains steady at 15% body fat, even after major knee surgery.

This is also very close to what I feed my pro athletes, though they get a bit more variety. I am convinced that if everyone ate the way I and my athletes do, most health issues would be eradicated.

I don’t really believe in supplementation, at least not in the way that supports a multi-billion dollar industry. There is no one supplement I’d recommend to everyone, and I especially don’t recommend supplements without first doing extensive bloodwork. I just don’t see the point of throwing money at a problem when you have no idea what the problem actually is.

However, I have done extensive bloodwork, so I know what my issues are and what supplements can be used to optimize.

For example, my sex hormones and DHEA levels are low and have remained low despite massive dietary changes and getting off birth control. This has been determined through multiple Dutch Tests, which measure hormone levels in saliva and urine. The whole thing is a mystery, but we’re starting by addressing it with maca and DHEA supplements. I expect to retest by the end of the year, and if things are still wonky, we’ll go into the world of gentle hormone replacement.

Additionally, my ferritin (iron) levels run low despite eating a lot of red meat, so I supplement with high quality, grassfed, dessicated beef liver which is one of the most nutrient dense foods on the planet. I also combine my red meat and liver supplements with vitamin C-rich foods like citrus and mango, because vitamin C enhances iron absorption. Remember, it’s not about the micronutrients you eat. It’s about the micronutrients you absorb.

Because I’m recovering from knee surgery, I’ve also incorporated extra supplements known to support ligament and tendon recovery, including collagen, creatine, and C:15 (brand name Fatty15), an odd chain amino acid that strengthens cell membranes and aids mitochondrial function. C:15 is an amino acid primarily found in fish skin and full fat dairy, two things humans don’t eat much of anymore. The science around C:15 is new, but in my recovery, I’m happy to throw everything at it.

Much of my 2024 health rabbit holes have revolved around how light affects the body and, therefore, unlearning all the crap about how sunlight is bad for the body. Much like nutrition and mental health, once you start pulling at the thread around the narrative of sunlight, the whole paradigm falls apart. I’ve stopped slathering myself in sunscreen, stopped wearing sunglasses unnecessarily, and invested in a large red light panel that hangs in my bathroom.

I’m not going to go into the details, because there are plenty of more researched folks who write about this. For a taste, check out Dermatology’s Disastrous War Against The Sun and Natural Light is An Essential Nutrient.

Red light therapy (RLT) works by exposing the skin to low levels of red or near-infrared light, which penetrates tissues to varying depths. This light is absorbed by chromophores in cells, particularly within mitochondria. The absorption boosts mitochondrial function, leading to increased production of adenosine triphosphate (ATP), the energy currency of cells. Elevated ATP levels enhance cellular processes, promoting repair, regeneration, and overall health. RLT also stimulates the production of collagen, a key protein for skin structure, which improves skin texture and elasticity. Additionally, it is thought to reduce oxidative stress and inflammation by increasing antioxidant defense mechanisms. All of these effects collectively accelerate healing, reduce pain and inflammation, and improve skin health.

I bought my red light panel post surgery to help heal my scars and give my body a boost. While I don’t have any control to compare, I can tell you that I’ve seen massive improvement in the skin on my face, and my surgeon looked at my 8 week old scars and said, “What’s your secret sauce that’s made those scars look so good?”

Finally, I’m deep in the world of peptides. Again, this came about as part of my surgery recovery strategy.

Peptide therapy involves using specific peptides, which are short chains of amino acids, to target various health conditions and enhance physiological functions. These peptides can mimic or influence naturally occurring peptides in the body, thereby modulating specific biological processes and improve hormone regulation, immune function, and tissue repair.

Specifically, I’m using injectible variations of the peptides BPC-157 and TB-500, which accelerate muscle and tendon repair, reduce inflammation, and enhance recovery from injuries.

The catch with peptides is that there aren’t any randomized clinical trials in humans, but there is a mountain of anectodal evidence and animal studies. Also, it can be tricky to find American-made, third party tested peptides that are 99% pure. I’m working with a specialist, so I trust where the peptides are coming from and know the exact dose I need for my body, but there is still a slight element of risk. So far, though, I’m having no issues, and think that the peptides are part of the reason why my knee recovery is going so well.

Today’s issue is a little different.

I am sharing a short essay I wrote sometime last year, that has yet to see formal publication. It comes in anticipation of my least favorite day of the year, July 3, the anniversary of my father’s death. Like all things grief, the intensity of the day itself is unpredictable. Some years, I forget about it entirely. Other years, I fall into a funk around Father’s Day and stew there until Fourth of July celebrations end. Last year, a wave of grief hit me in a coffee shop in Milwaukee, followed by a rush of excitement over the circumstances that brought me to Wisconsin in the first place.

This year…well…jury’s still out. It’s been six weeks since my knee surgery, and in between the stretches where it feels like a bulldozer is running over my psyche, the liminal space in between emotion and response has forced radical acceptance of whatever or whoever shows up.

The who of all this? My goodness. Both personally and professionally, a few extraordinary beings arrived without fanfare. When they came into my awareness, my first thought was: There you are. And a beat later: But why did you show up now?

There’s a sense of being out of time and place, of both the familiar and unfamiliar, of tying up loose ends while unraveling a new story. There is the distinct knowing that everything is linked, without any conscious understanding of how. There is a sort of energetic collision, a string of connection transforming from invisible to undeniable. An unspoken agreement, a heartbridge to another realm. Steady and beating, stirring up all that is unknown.

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Recently, while reading a memoir by a dear friend, Y-Dang Troeung, I turned the page and was greeted by a demure, black and white photo. I brought my right thumb and forefinger together and placed my fingers on her body, attempting to zoom in on the static, paper image. It was only after a few attempts that I realized what I was doing, and I burst into tears. 

On November 27, 2022, at the age of 42, Y-Dang died of pancreatic cancer—the same disease that took my father when I was fifteen. In the photo, Y-Dang is standing in front of “The Killing Tree” at Choeung Ek in Cambodia, where Cambodian infants were killed at the hands of Pol Pot and his genocidal regime in the 1970s. Her right side body faces the camera, small enough to fit within the center third of the photo, barely distinguishable from the bridge she stands on and the tree still caked with dried blood. 

A Canadian national bestseller, her book Landbridge: Life In Fragments, depicts snippets of Y-Dang’s life as the literal poster child for Cambodian refugees in Canada, all of it written during precious waking hours during the last year of her life. A career academic specializing in refugee studies, the work is all at once an elegy to the freedom and imprisonment of political asylum, a reflection of the Cambodian genocide told through her family’s lens, and a series of love letters to her young son, Kai. 

As is with all art, we view it through the lens of our experience. I cannot read Y-Dang’s words without stirring the ghost of my father, a man who—other than a loose connection to the same general war (my father fought in Vietnam) and cancer of the same name—bears no ties to the woman in the photo. Yet it is through Y-Dang that I have been turned to face the dregs of grief, and through her that I have found fragmented answers to hanging questions about my father’s death.

Did he know what was happening? Was there pain? What kind of pain? What would he have said if he could speak?

I can’t say for sure what I was looking for when I tried to zoom into Y-Dang. It is something I do with digital photos of those who matter to me, in moments of loneliness. The act of bringing their face toward me is comforting, somehow, and seems to strengthen the invisible string that tethers us together. But something is lost in images of those who are gone. In death, that string releases, replaced by a nebula of energy that is no longer linear, but everywhere all at once. Not being able to zoom in, not being able to see the image clearly, is the ever present unease of living. 

In the beginning of Y-Dang’s book, she quotes Michael Allaby’s definition of land bridge: a connection between two land masses, especially continents, that allows the migration of plants and animals from one land mass to the other. 

I would like to add a new word to the lexicon: heartbridge. A connection between two souls, seemingly distant from one another, who provide a path of release and understanding both to each other, and for those who stay behind. 

There are a handful of events in human existence that, when encountered, fundamentally shift perspective by connecting you to the greater experience of the human race. Having children (or so I hear), is one example. Falling in love, another. Grief. Wonder.

And pain. Physical pain.

Until a few days ago, I would have told you I’d experienced a few bouts of 10/10 physical pain in my lifetime. A serious ballet dancer in another life, I broke both my feet when I was 18, which I thought was a 10/10 until, at 25, a gynecologist hit my cervix during an IUD insertion. That oopsie led to two extra hours in the doctor’s office, curled and crying in the fetal position because I was in too much pain to walk. No migraine, no cut or burn in the kitchen, not even the aftermath of a car accident has come close to the agony of that IUD mishap.

When I blew out my knee on April 2, I remember thinking about how little it hurt compared to the damage I knew I’d done. An MRI confirmed the carnage: a full ACL tear, meniscus tear, burst Baker’s cyst, and a collection of Grade 2 sprains, bone bruises, and “marrow leakage.”

Still, when people asked if it hurt, I shrugged and answered, “Sort of?” I was in pain, sure. But it was manageable, tolerable. I thought of a 1995 study that found that ballet dancers have a significantly higher pain tolerance than non-dancers and figured my blasé attitude toward my knee pain (and kitchen burns, lost toenails, and cold water tolerance) had something to do with spending my youth dealing with the discomfort of pointe shoes filled with my own blood.

I rehabbed my knee for six weeks before my ACL surgery, ensuring that the leg was as strong as possible going into it. I figured the post-operative pain would be worse than the injury itself, but not so much that I couldn’t handle it. Around 175,000 ACL surgeries are performed every year. On average, that’s 480 people per day. I was going to be fine.

In times of injury, the body can go into shock. A drop in blood pressure reduces the flow of oxygen and causes blood vessels to constrict. Adrenaline is released which increases the body’s pain threshold. In some scenarios, shock is life-threatening. In others, like when I was in a car accident in 2014, shock simply delayed the pain.

The threshold of shock varies from person to person, scenario to scenario. Based on anecdotes and brief research, it seems most likely to happen during a sudden trauma as opposed to, say, a mixup with post-operative drugs, leading to anesthesia gradually wearing off without any painkillers in my system.

When I was 25 and curled up on my gynecologist’s medical table, I didn’t think it was possible for the body to feel that much pain without going into shock. That pain has been seared in my mind for thirteen years, mentally helping me through pesky accidents and injuries because as bad as whatever it was, it wasn’t like that.

And this wasn’t like that either. This was worse.

This was four deep cuts into skin, muscle, and bone being lit up by a femoral nerve that was coming back online. This was a quadriceps muscle paralyzed both by the nerve blocker and the missing quad tendon harvested for my ACL. This was modern Frankenstein, butchery in the name of medicine. This was the part you’re supposed to do with opioids, acetaminophen, and ibuprofen.

Instead, I rode out the night without the right painkillers, feeling the entirety of what it’s like to be sliced open and sewed back up. Though my mother was a phone call away, I didn’t yet know what went wrong and figured there was nothing she could do. I didn’t want her to see me in the state I was in, anyway. The sounds someone makes in that level of pain are different than your standard cry. It is guttural, more of a wail than a sob, laced with desperation and a wordless beg for mercy.

At one point I was sitting up, leg hanging off the side of the bed, attempting to move myself counterclockwise so I could lie down again. But the pain was too great to get the leg over the bed.

My mind jumped to the battlefields of the Revolutionary War. I saw a field, with soldiers in red coats fighting the Patriots, bayonets perched on the ends of muskets. I saw the blood-soaked ground, scattered with bodies sliced through the abdomen, the shoulders, the legs. I thought: this is what it’s like to be maimed in battle. Even amid the greatest pain I’d ever experienced, I felt a connection to the human race I’d never felt before. Since the dawn of humanity, how many people have felt this pain? Were they in shock, or did they endure every cut?

I eventually got myself prone, and then, into some variation of a side sleeping position that provided a minuscule level of relief. I remembered Ekhart Tolle’s directives on pain from The Power of Now, and how he said that in times of pain—including physical pain—be the one who observes.

“Focus attention on the feeling inside you. Know that it is the pain-body. Accept that it is there. Don’t think about it – don’t let the feeling turn into thinking. Don’t judge or analyze it. Don’t make an identity for yourself out of it. Stay present, and continue to be the observer of what is happening inside you. Become aware not only of the emotional pain but also of ‘the one who observes’, the silent watcher. This is the Power of Now, the power of your own conscious presence. Then see what happens.”

— The Power of Now, page 40

I also remembered how, when I was a little girl, my mother would walk me through meditations to lessen the pain of migraines. With my head on her lap, she would ask me to focus on the pain in my head and imagine it as a ball of light. Then, in a soothing voice, she said to imagine the ball getting smaller and smaller. Sometimes the ball would dissolve into a pinprick, other times she would have me give it away to an angel. It always made me feel better, at least until we got to a bottle of Advil.

This time, I had no physical ability to get to the collection of painkillers on my kitchen counter and hours to wait before I could call my doctor. I certainly couldn’t ignore the pain, but I could pay even more attention to it.

I closed my eyes and looked at the pain. In my mind’s eye it was a blue and black inkspot, morphing from my knee, up through my hip, and back down to my toes. The more I watched it, the less it felt like pain and the more it felt like experiencing pain. It is difficult to articulate the difference, but it’s like there was a beat in between the observation of pain and the feeling of pain. That beat provided just enough relief to get through to the next moment.

My heart rate began to slow and the wails quieted down. I struggled to keep concentration on watching rather than feeling, but when I noticed myself straying, I brought my awareness back to the blue and black inkspot. Eventually, I locked in enough to try another visualization. I thought of a glowing white IV bag filled with painkillers, floating above my body. I watched as the white liquid came toward me in a thin intravenous line, entering my body and flowing through my bloodstream. I watched it take over the inkspot, infiltrating the sludge.

I woke up in blinding pain some time later. I don’t know if two minutes or two hours had passed, but the fact that I had managed to doze off at all seemed like a minor miracle.

A few days later, at my first physical therapy appointment, my PT kept apologizing as he was examining my wounds, changing the dressings, and causing minor amounts of sting as he did his job. I brushed him off, assuring him that I had a new ceiling of pain thanks to my first night after surgery.

I know it was bad—and worse than the IUD—because my body has flooded itself with hormones to make me forget the extent of it. I don’t so much remember the pain as much as I remember the sounds of my cries, the way my dog ran into the closet, and the helplessness of not being able to move. I hope I never have to go through something like that again and yet, I feel an odd sense of camaraderie towards the millions of people throughout history who endured unimaginable physical pain without anesthetics.

And, despite the damage I think much of Big Pharma has done to the world, I know how grateful I was when the right painkillers finally worked their way into my system. The right tool for the right job does wonders. But the wrong tool for the wrong job?

Chaos.

“I too, feel depressed,” I texted my mother from an island rock perched in crystalline Lake Tahoe.

My mother’s passing feeling of depression was referring to two suitcases in the back of a storage closet. They hadn’t been used in twenty-three years, relics from the trip she and I were on when my father died. My feeling of depression wasn’t so much wrapped up in luggage, although the reminder didn’t help. Instead, it was—is—caught in the tendrils of a long, ongoing list of personal and professional misfires capped off with a full ACL tear. (I am in surgery as we speak. Or as you read, rather.)

Although nothing about my career, relationships, or general life satisfaction is thriving, most of my inner torture is attached to the actions of someone else. Without getting into specifics, I am waiting on a response to an inquiry that could change my entire life. I have formally been waiting since March, but really, I’ve been waiting for a year and a half. What began as a zygote of an idea grew into curiosity and was then fed with just enough fodder and uncertainty to create a perfect storm of compulsion, passion, and confusion. The torture is less about what answer comes from the inquiry and more about the insanity over why this is happening in the first place. Is it destiny? Life purpose? Misguided desperation? I fixate on concrete interactions that brought me here and then fight the delusion that comes from dreaming so big in the first place. I search Twitter and Google News for updates and extrapolate data from folks who have no idea they’re supplying breadcrumbs to someone desperate for a nourishing meal. The whole thing has pulled a melancholic veil over my world, something that even a Wednesday lounge by the blue waters of Tahoe couldn’t lift.

I came home from the lake and turned to my coping mechanism—oil painting—until it got dark. Mid brushstroke, egged on by the minor chords of Shane Smith and the Saints’ “Little Bird,” I failed to fight back tears of exhaustion, longing, and frustration. While chewing on a (bad) idea I thought might take the edge off the ache, I remembered an old journal scribbled with something relevant to the bad idea and, upon cleaning my brushes, went looking for whatever I’d written down.

In big letters, I’d written a word I’d never heard of and had never bothered to look up: limerence.

A quick Google took me to The Attachment Project’s definition of limerence:

The experience of having an uncontrollable desire for someone – an obsession that consumes the limerent person’s thoughts, feelings, and behaviors. It usually involves two people: the person who desires the other (the limerent) and the desired person (the limerence object or LO).

Essentially, limerance is a state of being stuck between uncertainty and hope: will they or won’t they return the sentiment? For instance, perhaps this person hasn’t rejected them entirely, but they haven’t confessed their love either. 

This state of irresolution causes the limerent to become preoccupied with the LO, closely analyzing their behavior and body language to look for signs of reciprocation. They may also ruminate about past encounters with the LO and fantasize about what might happen between them in the future. The key feature of limerence is that these thoughts and yearnings are uncontrollable and all-consuming. 

As I went down a limerence rabbit hole, I wondered how I’d gone 38 years without learning this word. Limerence is usually associated with romantic love, but it doesn’t have to be. Friendship, family, mentor/mentee—any relationship involving two people can go wayward with limerence. For me, it explained everything.

Instantly, I felt better. I even looked dog and said, “Holy shit, that’s it!” How good it felt to be seen, to have the irrationality explained, to read accounts of other folks on r/limerence whose crazy was just as bad (and worse) than my own.

The epiphany gave me odd permission to do all the things I knew I needed to do but couldn’t quit. I unsubscribed from news platforms that might carry a snippet of information, unfollowed a few players in the space, and muted decision-makers. I will get an answer this year. Everyone involved has each other’s phone numbers. That was true before and is still true now. The difference is that in putting a name to the crazy, I am now able to shift into waiting without being consumed by thoughts.

It didn’t take long for me to draw a parallel between my elation over having a name for my distress and the (sometimes literal) party people throw for themselves when, after years of suffering, they get a formal mental disorder diagnosis. Twitter is full of tweets (and arguments) over adults to celebrate the ADHD, AuADHD (Autism/ADHD), or bipolar diagnosis they receive in midlife. People become so enmeshed with their diagnosis that it ends up in their bio, right next to their other primary descriptors: proud mom of 3, chemist, AuADHD.

I am, admittedly, quite judgemental over this kind of behavior. I can’t pinpoint exactly what bothers me, but it lies somewhere in the space of over-medicalization + over identification + taking resources away from folks who actually need it. Marcia, the offbeat, fiftysomething part-time jewelry maker may feel quirky and “off” in the world, but if she lives independently, pays her bills on time, and contributes to society, is she really “disordered”?

Hell, my sensory issues, mood swings, and general frustration with people land me on the spectrum of high-functioning autism. More than one person has asked me if I’m neurodivergent, which pisses me off. Again, I can’t pinpoint exactly why. Perhaps it’s because the suggestion itself indicates that someone wants to force me into a box, which, if you know me even a little bit, is the quickest way to make sure we never speak again. My gut reaction to the question is even less attractive. It’s something along the lines of: Who gives a shit? Stop searching for trendy explanations and go create something with your life.

And yet, learning the meaning limerence was like someone taking off mental handcuffs.

I am well aware of my bias. After seven years in the antidepressant withdrawal and overmedicalization space, the three words most likely trigger an eye roll are stigma, treatment, and validation. Drug makers are advocacy groups biggest donors, which puts a damper on “awareness” and “anti-stigma” campaigns. May may be “Mental Health Awareness Month” but if it were honest, it would be called “Psych Drug Advertisement Month.”

Treatment is a sneaky little way of using common languange to medicalizing a psycho/social/emotional issues. Just like Eli-Lilly’s clever 2023 tagline rebrand from “Powered by Purpose” to “A Medicine Company,” it’s about treating the patient, or ensuring access to treatment. What sort of monster wouldn’t want someone suffering to get the treatment they deserve? “Treatment” is medical care for an injury or illness, synonomous with drugs and diagnosis. It is not healing, building resilience, facing issues, making difficult decisions, or daring to accept that sometimes you are the problem.

And then there’s validation, both a powerful force for positive change and destruction. Validation when it comes to sorting out an issue and being understood by another human? Good. Validation from external sources and the constant need to have feelings recognized? Not so good.

The difference, I think, is what happens after validation is received. Productive validation identifies an issue and, through the act of recognition, diffuses its intensity. I recognized myself in the definition of limerence and used the tools provided to quiet the symptoms. Unproductive validation is righteous and only intensifies the feedback loop. Had I seen the definition of limerence, felt seen but not taken action, all I’d be doing is shifting the blame. A lightbulb that illuminates the whole picture versus a spotlight that blinds everything outside a defined edge.

Or, as Oxford researcher Lucy Foulkes recenty said in her New York Times opinion piece, “High-Functioning Anxiety isn’t a Medical Diagnosis. It’s a hashtag” :

All this awareness oversimplifies and maybe even popularizes mental disorder…and over interpretation can become a self-fulfilling prophecy…if everyone is ill, no one is.

Ever since MAY CAUSE SIDE EFFECTS was published in 2022, I’ve done as much press as I can without bankrupting my savings account or my soul. Podcasts are my favorite outlet, and after years of refusing, I finally caved and got on TikTok with the intent of reaching a withdrawal-specific audience. 

A few weeks ago, I shared a clip from my episode of Relatable with Allie Beth Stuckey, a massive podcast with loyal listeners. On both Instagram and TikTok, the post blew up, launching me into the weird world of internet virality. In many ways, I’ve been training for this since I started speaking publicly on antidepressant withdrawal in 2018. I’ve honed my message, backed up my personal story with research, and learned how to talk about it without treading into the litigious world of formal medical advice.

Still, nothing quite prepares you for the onslaught of notifications when a post goes viral. Instagram has a short half-life. Viral posts die within a week or so. TikTok is different. The algorithm keeps feeding it back into the funnel, like riding the same ride at the carnival over and over again. Combined, the clip has over half a million views with around two thousand comments. 

What I am most surprised by is the lack of pushback compared to the volume of psychiatric horror stories. Typically, anti-antidepressant content generates a decent amount of criticism. Whether it’s my work or someone else’s, you see a lot of, “Antidepressants save lives!” and “Stop shaming people for seeking the treatment they need.” Point out the FDA-supported data suggesting that antidepressants actually take lives in people under 24 and have no effect on suicidality for those 24-65, and I’m usually met by a reductionist, personal anecdote that culminates in, “What you’re doing is DANGEROUS.”

Sometimes people get cranky because I’m not a doctor or researcher, to which they say, “and what are ur credentials?” Unbeknownst to them, this is the one line that makes me doubt what I’m doing, so much so that after some rando made this comment I started researching online masters programs to see if I could get a quickie degree. I’m not bothered because I don’t have letters after my name. I’m bothered because I don’t know what I don’t know. I wonder if my bias is causing me to miss something that could hurt someone. Somehow, my lizard brain thinks having an advanced degree would protect me from that bias, which is ironic because the whole problem with the current standard of care in mental health is that clinicians are blind to the pharma/diagnostic bias programmed into them during their advanced degrees. 

Credentials buy you an expensive certificate that says, “I’m good at memorizing the stuff required to pass a test.” The art of medicine or therapy—and the critical thinking required to question why people aren’t getting better despite more intervention—only comes with time and practice. And after 10+ years of by-the-book education, very few practitioners have the self-awareness or balls to say, “I don’t know what I don’t know. I wonder if my bias is causing me to miss something that could hurt someone?” 

Thus, millions of people around the world are being hurt by people with letters after their names, yet somehow I’m the problem. 

When these comments get to me, I try to remember that being an MD doesn’t shield you from bullshit. Dr. Will Cole, a major player in the functional medicine space, recently shared a post on Instagram about the evidenced-based placebo effect with antidepressants. It garnered so many negative comments that the post is now deleted. Will told me in a podcast we did together that the response made him not want to talk about the topic at all. 

For my posts that went viral, the ratio of positive/like minded comments to nasty ones is about 100:1. Whether it’s sample bias from the algorithm or people finally feeling safe to air their grievances about shit doctors and bad drugs, I don’t know. But in the comments of one video, there are over 1600 horror stories just about Effexor. If this were in a specialty that uses lab tests to determine disease, that would be a class action lawsuit. It’s not a class action lawsuit in psychiatry because there aren’t any empirical tests to measure mental and emotional symptoms. A group of people claiming Effexor-induced suicidality cannot prove that Effexor was at fault, and all the pharmaceutical lawyers have to do is point to the patients’ clinical history and blame their suicidality on the depression diagnosis the patient inevitably received. Clever, innit?

The deluge of comments does inspire me to keep chugging along, though. Many folks talk about how they thought they were alone until they stumbled upon my post. This work can feel meaningless because it feels like the needle isn’t moving, and I often wonder if I’m wasting my time. I needed this boost as much as the folks in the comments did. 

So, if you’re new to my substack from one of these podcasts, thank you for being here. I’ll keep doing the work if you do. 

The title, basically, which is why this issue is a day late.

Last week, I tore my ACL after taking a bad landing during practice for a gymnastics meet I was supposed to compete in this week. Everyone who hears about it wants to tilt their head and make some comment about getting older, which pisses me off because this injury was the result of gravity and physics, not age. The only time I’ve been feeling my age is when I look around at the world and simultaneously think, my god, I’ve been around long enough to see the bullshit double back on itself and come back again and also I’ve still got a lot more of this left to go.

In theory, anyway.

I can’t say I’ve been thriving over the past eight months, and this injury and its long road to recovery isn’t exactly righting me on the road to flourishing. I’m not looking to beleaguer you for pity or words of encouragement. They’ll roll right off me and I don’t want to hear it. I only bring it up to convey the state of mind I’m in, which is probably why I’m purposely picking a public fight with Harvard psychiatrist Roy Perlis, who with all his Ivy League wisdom, truly thinks it’s a good idea to make antidepressants available over the counter.

On April 8, Stat News posted an opinion piece by Perlis titled, “The time has come for over-the-counter antidepressants,” wherein Perlis argues that antidepressants should be available without a prescription, just like ibuprofen or laxatives. (Don’t bother rewarding Stat with views by clicking the link. I’m going to break it down below.)

As sure as I am about the overall harm caused by casual, mass psychiatric drugging of the human psyche, I still leave the door open for counterarguments. I consider it part of my duty to stick to my guns only if they’re loaded, which means forcing myself to get out of the echo chamber and hear opposing opinions. So I read the piece, expecting a Harvard professor to at least make a well-substantiated argument, even if I didn’t agree with it.

Instead, it’s 900 words of one of the dumbest, most poorly cited pieces of “journalism” I have ever read in the mental health space. And that’s saying a lot, given the drivel that comes from pop-wellness websites.

Let’s take a look, paragraph by paragraph. Perlis begins:

Anyone can now walk into a pharmacy in the United States and buy oral contraceptives over the counter without a prescription, thanks to the FDA’s approval of norgestrel (Opill). This change reflects the drug’s safety and the public health imperative to ensure wider access to birth control. But another safe class of medicine that addresses a massive public health need remains unavailable except by prescription: the antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Let’s start with the immediate oddity. Why in the world is Perlis comparing an SSRI to hormonal birth control? What do these things have in common other than being a political football? If he’d instead compared an SSRI to over-the-counter supplements that act on the serotonin system, like St. Johns Wort or tryptophan, then maybe we have the basis for a relevant argument. Instead, he chooses birth control (in all likelihood to signal that he is not one of the Bad Men who took women’s rights away) and throws the word “safe” in front of both of them, as if there is any 100% safe medication. All interventions carry risk, and half the point of a doctor is to assess whether the risk of treatment outweighs the risk of the illness. Perlis sort of addresses this later in the article, but even by using the word “safe” in such a casual way, he is grossly generalizing while also patronizing readers.

These medications, which have been used in the U.S. for three decades, have repeatedly been shown to be safe and effective for treating major depression and anxiety disorders.

There’s that word again, right above the fold. Note how there is zero reference to support this. We are supposed to take his word because of the letters after his name. When someone else on Twitter pushed back against the safety claim with a study questioning antidepressant safety, Perlis chastised the user for “spreading misinformation” and then linked a meta-analysis he co-wrote along with a dozen others as evidence for antidepressant safety. I looked that paper over and noticed that at least half of the authors had declared conflict of interest statements. I responded to the tweet, asking Perlis why he would use a paper with so much declared conflict of interest to support a pro-pharma argument. Perlis blocked me along with the original user who called him out, and his response with the problematic paper is now deleted.

Perlis goes on to list the usual mental health woes including increasing rates of depression, long wait times for mental health services, and oddly, telehealth services whose quality of care is “difficult to measure.” He does not elaborate on how removing any clinical professional from the equation would improve measurement, but that’s par for the course for this dialogue, so I’m going to blow past it and focus on more egregious issues.

In reality, many OTC products treat symptoms or rely on consumers to diagnose themselves — think yeast infections, acid reflux, or respiratory infections. In the case of major depression or generalized anxiety, screening surveys have been developed for primary care that could help people determine their likely diagnosis with at least the degree of confidence of many OTC applications.

Ah yes, the screening survey. In no other area of medicine does a doctor make full diagnoses and prescribe solely based on a patient’s answers to a handful of leading questions. It’s working so well, too! People are thriving after being asked if, in the past two weeks, they’ve felt hopeless. Please circle “a little, sometimes, a lot of the time, or all the time.” And after you do that, we’ll give you a drug for the despair we can’t measure and convince you it’s your brain chemicals, stupid.

What about use or misuse? Depression is associated with increased risk for suicide, and medication overdose is among the most common methods of suicide. But walk through the aisles at your local pharmacy and pick any given medicine off the shelf: the odds are good it is more dangerous in overdose than an SSRI. Fatal overdoses are far more likely to involve drugs other than antidepressants.

Here’s where he really starts to lose me. Perlis uses overdose to defend his reasoning for the safety of SSRIs, claiming that it is more likely to overdose on other OTC drugs rather than SSRIs. This is bizarre because a Harvard psychiatrist should know that most people commit suicide by firearms or hanging and that even amongst poisonings or overdoses, people aren’t using their bottle of Zoloft to do it.

I’m unclear if Perlis was trying to make the argument that antidepressants are less fatally toxic at high levels than other OTC drugs, or if he’s trying to create a red herring that distracts people from the fact that suicidality and suicidal thoughts can be induced by antidepressants. I initially thought it was a poorly constructed argument for the former, but the next paragraph muddles it.

Among people age 25 and older, there is clear evidence that taking antidepressants does not increase the risk for suicide — in fact, the risk of suicidal thoughts or acts is reduced in this group, particularly among those 65 and older. For those younger than 25, the risk for suicidal behaviors or thoughts in clinical trials was modestly greater than that of placebo. So buying SSRIs over the counter could be restricted to people 25 and older, at least at first, just as some states restrict OTC pseudoephedrine (Sudafed) purchases to people age 18 or older.

Perlis is pulling data from a review by the FDA that examined the effects of black box warnings on antidepressants. Thanks to this study and others, it is well known that antidepressants increase suicidality significantly in younger populations. (A recent study used to approve the use of Lexapro for 7 to 12-year-olds documented a 6x increase in suicidality among kids who were put on the drug…and yet it was still approved by the FDA. See Dr. Roger McFillin’s take on that absurdity, here.)

It is incomprehensible to me that a psychiatrist in good standing would not only suggest a drug with a black box warning should be available over the counter, but that we can mitigate that risk by simply ID’ing whoever is buying it, as if the drug couldn’t then just be given to those under 25 as soon as the buyer walks out the door.

If Perlis ever grants me the interview I asked of him on Twitter**, my first question would be this: If some fifteen-year-old hangs themselves two weeks after starting OTC sertraline bought for them by their parents, who is responsible? The kid? The parents? Or the teller ID’ing folks at CVS?

Another objection to over-the-counter SSRIs is that not everyone believes in pills for depression. Some still question the biological basis of this disorder, despite the identification of more than 100 genes that increase depression risk and neuroimaging studies showing differences in the brains of people with depression.

Perlis goes on to draw an odd line between people not “believing” in the biological basis for depression and a study that looks at neuroimaging biomarkers as well as a Scottish study that concluded that people who “carried over 100 [changes to their DNA] were much more likely to develop the disorder in future.”

First off, the neuroimaging study he linked was connected to identifying the individuals who are most likely to benefit from targeted neurostimulation therapies, NOT antidepressants, which makes that reference null. Second, even if we did have the ability to easily test for these 100 or so mystery genes that cause depression (according to one study), does Perlis expect every person who walks into a CVS to have completed a full neuroimaging evaluation or DNA test before purchasing their sertraline with their toilet paper? If not, then how can you argue that this would be a broadly effective strategy?

To be sure, there are alternatives to pills. Certain talk therapies, like cognitive behavioral therapy, can be as effective as antidepressants, and some people prefer talking with a therapist to taking a medicine. But not everyone: weekly visits for eight to 12 sessions or more can entail substantial time and money. Here too, access to psychotherapists is a massive problem, particularly for individuals who seek to use insurance, or have none.

What this is saying is that Perlis is perfectly okay mass drugging lower-income folks under the guise of do-gooder benevolence. Please refer to the rise of Nazis for historical precedence on how that works out.

No treatment works for everyone, but around one in three people with depression get well with an initial antidepressant medication. Allowing over-the-counter access is not a panacea, but could open the door to a safe, effective, and inexpensive treatment for many who need it.

Perlis uses the STAR*D trial to report that one in three people who take antidepressants get well. Putting aside the recent calls to retract the STAR*D trial results due to significant violations of the originally submitted research protocol, Perlis’ own argument still suggests that the majority of people do not improve on antidepressants. Yet his strategy would expose 2 out of 3 people to iatrogenic risks and side effects of these “safe” drugs including but limited to suicidality, violent aggression, irreversible sexual dysfunction, mania, and damage to fetal development.

What’s needed to make this happen? An SSRI manufacturer with the courage to engage with the FDA and invest the necessary resources for a prescription-to-OTC switch, a well-trod path that has previously included medicines for allergies, acid reflux, and emergency contraception, among others. This process would primarily involve studies to prove that consumers can understand and follow the medication label, not new clinical trials, because more than three decades of evidence shows that SSRI antidepressants are safe and effective.

Perlis closes with a call to action from pharmaceutical companies, convenient because it absolves him of any downstream responsibility. He also continues to push the thread that depression is just as simple as contraception or acid reflux, even though those ailments occur due to a single, easy-to-explain mechanism. The same cannot be said of depression. Even in a world where biology was the sole explanation, it involves various processes (and apparently, over 100 genes) which means no single antidepressant would be suitable for all.

**Since Monday, this article is making its way around Twitter and I’m now not the only one picking a fight with him. However, in an odd twist, Perlis agreed to an interview with me. We’ll see if that materializes.

On March 8, 2017, I published a post on Medium entitled, “Finding Happiness Through Factual Optimism (Even When Life Goes Sideways.)”

The essay, even with its amateur prose that now makes me cringe, explained the system I created for myself to objectively track my progress when I was healing from antidepressant withdrawal and fifteen years of chronic depression.

At the time, I recognized two things:

So I did what I do best—go in a completely different direction and find a way to quantify the shit out of my feelings, then measure them against a very low bar of success! Because fuck gratitude, right? To quote myself from my book, on page 100 of MAY CAUSE SIDE EFFECTS: Gratitude is the bow we tie around our brand of shit to convince ourselves our particular pile of shit is a pretty pile of shit.

My feelings have changed on this, as I’ll address later, but at the time, rejecting gratitude was a form of taking back my power. I was just trying to survive. Gratitude was too advanced, and I needed to aim lower.

The lowest bar, I reasoned through a black and white lens, was that life would be worth living if it trended positive 51% of the time. That’s 2.6 “good” days per week, where “good” is defined by having the day itself trend 51% positive. String enough 51% days together, and you’ve got a 51% life objectively worth living. How’s that for data you can’t argue?

With a yardstick in place, I set about tracking and quantifying the data with the objective of a 51% Lifetime Happiness Average, whereby my choices were validated by default. My goal was never to reach a Utopic level of constant joy. I knew 100% Lifetime Happiness was impossible, but even 80% felt like a stretch. The gratitude gurus lived at 80. I just wanted to dig myself out of 20.

So, at the end of each day, I opened a journal and assigned myself a Daily Happiness Rating based on how the hell I was feeling at that moment. I used a 0-100 scale to allow for nuance. The difference between 49 and 51 was monumental, so it seemed right to give respect to the weight of each integer. Still, knowing that feelings aren’t facts, I didn’t overthink the number. Good morning, bad evening? Give it a 48. Horrific day filled with intrusive thoughts? It gets a 10. A window in the world of withdrawal, in which I didn’t break down in tears? Assign the day a 60 and hope for a 61 tomorrow.

Then, I plotted it all on a line graph.

The drop in February occurred when I went into antidepressant withdrawal. The uptick in August happened when I boarded a one-way plane to Malaysia and was temporarily spellbound by the thrill of a new place. Then, predictably, the high wore off leading to a September crash, followed by an uptick.

When zoomed out, this looks like a person healing. Which, it was. But zoomed in, the day-to-day felt volatile because it was:

My monthly charts from 2016 would reflect a much lower day to day experience, but in February 2017, nearly a year into withdrawal, I was having more 51% days than not. Still, when I went down, I went down hard.

Plotting this over a lifetime, as defined from the year my father died when I was 15 up until the end of 2017:

This is how I proved to myself that I was, objectively, getting better. I could not argue with the system I put in place. The only metric was how I felt, and I didn’t need to rationalize why I felt one day was a 38 while another was a 64. They just were, and that was good enough.

This process allowed me to have bad days, even bad weeks, while knowing that the only goal was a 51% lifetime average. This low bar both took all the pressure off and allowed me to look at individual decisions and determine how they’d affect my overall happiness average. Some decisions were easy. Making my bed certainly contributed to increasing my chances of a 51% day, and so would going to the gym rather than getting ice cream.

Other decisions were more nebulous or didn’t seem to have a clear upside. When those choices came up, I trusted that I’d banked enough smaller 51% decisions (like making the bed) to make up for a choice that might lower the overall average. Over time, I became better at recognizing when a choice was good for me while also forgiving myself for the days when things just fucking sucked.

I stopped tracking in early 2018, when I stabilized enough for the graphs to get boring. When the graphs got boring, something magical happened: I recognized gratitude.

What I’d missed about gratitude is that it is a feeling, not a thought. You cannot think yourself into it, which is why gratitude journals never worked for me. I was too full of muck for the feeling to appear, but once I cleared enough of the muck and analyzed all my little day-to-day choices, I began to notice the little spark of gratitude—a lazy moment in the sun with my dog, the smell of coffee, the color of a flower—all of which eventually grew into a campfire.

That is when I finally understood that gratitude is the way out of suffering. Because once you build that campfire, the world is filled with logs to keep it burning. Even in during painful experiences or crushing, a strong fire stays lit.

It is this duality that makes for a life truly lived at 100. For a long time, I thought a Lifetime Happiness Average of 100 was unattainable because no one can be happy all the time. This is true, of course, but what I know now is that the 100 contains within it all human emotions and experiences. To live at 100 is to experience the full depth of despair and uncertainty because it is matched by intense awe and love.

I know this because I now know love in a way I didn’t before. I know how love is all at once the most painful and beautiful experience, one that simultaneously makes you want to hold on to every moment and also die immediately, just to stop the ache of losing it. It is extreme and all-encompassing, encasing all the meaning of 0-100 within it.

What a gift it is to feel it, to not only want to live in a world bigger than 51%, but to welcome the extremes on either end. Where black and white, dark and light, good and bad are no longer opposites, but integrated expressions of a life well lived.

Inevitably, when you write a book about a growing global concern like antidepressant withdrawal, people reach out with questions. And even though I’ve received hundreds of inquiries in the year and a half since MAY CAUSE SIDE EFFECTS came out, I haven’t bothered to create an FAQ. As much as general themes repeat, people’s stories are unique, and canned answers rarely come in handy.

Instead, I try to answer each person individually and at the very least, ensure that they feel heard for a moment. In most cases—80%—this is all that’s needed. When people have been gaslit by doctors or have spent the majority of their lives under the influence of powerful psychiatric drugs, sometimes the difference maker is nothing more than someone validating their experience. That little bit of encouragement is enough to keep them on course and usually, I never hear from them again.

The remaining 20%, like all 80/20 relationships, take up most of my correspondence time. Typically these are the more complicated cases, usually from folks whose friends likely describe them as “a little neurotic.” These are the overachievers, the philosophers, the Type-As control freaks who did not schedule antidepressant withdrawal into their five-year plan.

This phenotype wants to do everything in their power to make withdrawal go away as fast as possible and can be found furiously googling and going down unhelpful rabbit holes on withdrawal forums. They also usually have money—depression is a privilege as it turns out—and are willing to spend it if they only knew what tests to get.

Of course, their doctor doesn’t have a clue, so when a basic blood panel comes out clean, the prescriber dismisses the idea of running more tests. The patient, though, knows something is amiss. Inn googling, these people find me and fill my DMs, which leads me the meandering point of this issue: every medical test I’ve been through to heal myself after fifteen years of antidepressants.

I took my last antidepressant in 2016, considered myself fully through antidepressant withdrawal in 2018, and spent the better part of 2021 – 2023 healing my body from the ordeal. I spent 2019 and 2020 tinkering with my diet in hopes of figuring out what was causing my gut issues and general I-feel-like-shit issues. I cut gluten or dairy or coffee. I ate less protein. I ate more protein. I juiced celery and drank fennel tea. I went to gastroenterologists who looked at me over a clipboard and said, “We can schedule a colonoscopy?”

Finally, in 2021, I called Andy Galpin, PhD., an old friend who, along with nutrition savant Dan Garner, was working with professional athletes to heal their lingering issues and improve their physical performance. Dan & Andy let me go through their program, which kicked off a two years of lab work and serious dietary changes that have finally allowed my body to heal and perform its best.

(I’ll cover my diet and the results of these tests in another issue. I’m on the road doing press for the paperback release of MAY CAUSE SIDE EFFECTS.)

Over a two year period, I’ve spent well over $10,000 out of pocket on lab tests. It is no small amount of money, especially given my super-lucrative career as a freelance writer and chef. (I recently received a royalty check for the amount of thirteen cents!)

Insurance hasn’t covered a dime, and still, it’s the best money I’ve ever spent on myself because I actually feel better. The key is to get all the testing done in a 1-2 week time period so you have a full picture of your health, all at once. This allows for the Dan Garners of the world to connect the dots between the body’s different systems, rather than isolating the endocrine/gut/blood labs in a vacuum and assuming nothing is connected, like allopathic medicine likes to do.

So, have at it folks. Go forth and figure out your shit. Literally.

Food Sensitivity:

MRT test

Hormones:

Dutch Test

Gut/GI:

GI Map

Heavy Metals:

Doctor’s Data Toxic & Essential Elements: Hair

Genetic:

GeneSight

Blood:

Complete metabolic blood panel

HNK1 (CD57) panel

Microscopic examination

Urinalysis, complete

C-Reactive Protein, Cardiac

Ferritin

Fibrinogen Activity

GGT

Hemoglobin A1C

Homocyst(e)I’ve

LDH

Lipid Panel with Chol/HDL Ratio

Magnesium

Phosphorus

Reverse T3, serum

Thyrogobulin Antibody

Thyroid Peroxidase TPO Ab

Thyroid Profile II

Thyroxine (T4) Free, Direct

Triiodothyronine (T3), Free

Uric Acid

Vitamin D, 25-Hydroxy

For months, I’ve felt like I just got on one of those carnival rides where you sit down, strap in, and let a rusty elevator take you to the top of a tower. Even though the elevator is gently taking you away from familiar ground, you know that at some point, the elevator will stop, open its doors, and give you a view of the world you’re about to drop into. And then, just as you relax into the view, the floor will fall away and gravity will take over, leaving you with no option other than to feel the rush.

I keep waiting for the elevator doors to open and show me a new world. It is coming. I can feel it and I’ve been feeling it for months. In October, I lost my main client and most of my work evaporated overnight. I challenged myself to simply wait, as itchy as it was because I could feel this something coming. I could feel myself standing in line, putting on a seatbelt, and waiting to move.

Every few years I seem to come back here, to a place of uncomfortably long stagnancy with no clear direction. The last time this happened was in August 2017. I was at the tail end of both a year of international travel and a year and some months of antidepressant withdrawal. I didn’t have a job or an address, but I had signed a flimsy book deal for a book called LADYBALLS. Though I still love the title, that book never came to be, but its existence contained the zygote of what would eventually become MAY CAUSE SIDE EFFECTS.

On a rooftop in Buenos Aires, I wrote myself a letter and dated it January 1, 2018. Why I thought six months was an appropriate open date, I don’t remember. But I do remember that when the new year rolled around, I looked at the unopened letter and knew it wasn’t time to read it. Days before, the book deal for LADYBALLS fell apart. I fired my agent and my publisher in a blind move that turned out to be the best career decision I’ve ever made. I couldn’t remember the specifics of the letter, but I knew if I opened it, I would only feel frustration and shame. So I stuffed it in a folder and forgot about it.

Until yesterday.

My strategy for dealing with general overwhelm is to spontaneously deep clean my home. Typically, a stressor appears—good, bad, doesn’t matter—and within a day, I decide my house is unacceptable. I am already known to vacuum in the middle of a dinner party, but this takes it to another level. In the words of Monica Gellar, the compulsive chef on Friends: “Not just health department clean. Monica clean.”

Yesterday, I signed a contract with a new client, thereby imbuing me with all sorts of problems to solve. After attempting—and failing—to solve all those problems in one morning, I came home and began scrubbing the screws on my toilet. Which led to re-lining drawers. And going through my closet. And cleaning out my desk, where I found a brittle, unopened yellow envelope dated January 1, 2018.

I smiled, sure that inside the letter was something about a $50,000 book deal that never materialized. Enough time had passed and I figured I could handle whatever was in there, even if what was in there was nothing but disappointment.

The back side:

I chuckled at the line, “By the time you read this, you’ll know where you’re going to live.” That is the only bit in there that isn’t quite settled. Something on the carnival ride feels like I’m not staying put much longer.

Everything else, though, has manifested. I wrote the book. And it’s good. And I finished on time, and I am happy with the words I wrote and the things I believe. The money came, too. And that independence. Real independence, because that year and these years gave me the gift of confidence and a voice—a true voice.

By the time I opened this, I had an address to come home to. And I can pay for it. And I am surrounded by people who love me. The negativity that followed me is a distant memory. I am me. And I am paid to be me. I am content, happy, full, and free.

I can’t remember if, when I wrote the letter, I really believed any of it would come true. I knew I wanted to believe, and that I’d seen glimpses of light during antidepressant withdrawal that at least taught me I was capable of experiencing a life I never imagined.

I share this with you because I can feel that I’m reaching the top of the elevator and that when it opens up and the ride truly begins, I know my story is going to reach even more people. So far, I’ve been able to keep up with the amount of correspondence I receive from people suffering from antidepressant withdrawal. Sometimes it takes a while, but I get there. I don’t know how much longer I’m going to be able to respond to everyone.

So, for everyone who is suffering, let this letter serve as an example of possibility. This can be your future if you keep the course and keep doing the work. Most times, the hard way is actually the easy way. Let it be hard. Feel it. Process it. Because at the other end is light.

Light

Light

Light

Light

Light

Light

Light

Joy

Love

Acceptance.

Hi friends,

When you’re reading this, I will be on my way to another continent to celebrate both my mom’s and my birthdays. And on the day of my birthday—February 1—I will have 16,715 more days to live. 

Maybe. Hopefully.

My father died suddenly when he was 54. That means he was halfway through at 27 and still had 13 years of living before I came along. I don’t have the vocabulary to express how much that twists my mind, and yet it’s been a constant thought over this year. I don’t know if it’s because 54 no longer feels all that old or far away, or because no one ever knows when they’re halfway done. 

I turn to numbers for comfort. Always have. Even as a girl, when I felt overwhelmed, I would quietly calm myself by counting ceiling tiles or cars passing in the other direction. 

In the depths of depression—despite years of antidepressants—I took a dozen life expectancy tests, sourced from life insurance companies and accounting firms. I averaged the results for a total of 83 years, 9 months, and 6 days on this planet. Or 30,595 sunsets.

I didn’t want those sunsets until I got off all the antidepressants and came out of a year of severe antidepressant withdrawal. But after all the suffering and all the deep work, finally, I want time. I want all the days I never thought I’d have. 

If I am so lucky to see them all, that means I get to watch the leaves turn 46 more times. 

And read just 920 more books. 

And watch 11 more Summer Olympics. 

There will be maybe 138 more pizzas and 33,430 cups of coffee. Assuming there’s always a canine by my side, I’ll take 66,860 more walks with 4 more dogs. 

I’ll hug that friend I only see once every few years about 15 more times. 

And feel lucky if I laugh until I cry 92 more times. 

Maybe I get half a dozen moments of complete and utter awe. 

And one great love. 

Maybe. Hopefully. 

All this to say: 

I don’t know how many more mother/daughter trips I have left, especially grand international ones. I will be happily unavailable for a few weeks and want to make sure you have your fill of the latest news on antidepressant withdrawal, so I have compiled a bunch of recent articles below.

There was a time when maybe one article was written on the topic every three months, and now I’m starting to see weekly (and even daily) headlines. Something is shifting. I can feel it, and I welcome it.

The STAR*D trial, once considered a landmark study in psychiatry, is now mired in controversy due to findings of protocol violations, inflated remission rates, and a general lack of accountability from its investigators.

One of the largest and longest studies on antidepressants, the trial initially reported a 67% effectiveness rate for antidepressants, which became the basis for the pharmaceutical focus that has shaped much of modern psychiatric “care.” However, the trial has come under scrutiny for several reasons, revealing a far different picture of its findings:

I awoke this morning, on New Year’s Day 2024, from one of those deep sleeps that makes you wonder if you ever really sleep at all. I have been sick for the better part of the holiday season, in every sense of the word—physically sick, heartsick, lovesick, grief sick, job sick—and most of my nights have been fitful, either because of a hacking cough or the prickly agitation that comes with the sort of longing that NyQuil can’t shake off.

The chest infection combined with other people’s holiday obligations meant that I spent most of the back half of December alone, an experience I am deeply familiar with after years of working in the Manhattan restaurant industry. In food service, someone has to work the Christmas Eve rush, frost New Year’s cupcakes, and cater Thanksgiving dinner to folks who don’t cook. Even if the business is closed on the actual holiday, someone has to work the day before and after, rendering cross-country travel impossible.

Thus, my clearest holiday memories are not of cozy, matching pajama-clad mornings, but of a Christmas dinner of Caesar salad and buffalo chicken wings at the Jewish diner underneath my apartment, long walks with my dog down silent Manhattan streets, the deep sense of toska pulling at my heart.

Goddamned toska.

A Russian word with no English equivalent, Vladimir Nabokov said it best: “At its deepest and most painful, it is a sensation of great spiritual anguish, often without any specific cause. At less morbid levels it is a dull ache of the soul, a longing with nothing to long for, a sick pining, a vague restlessness, mental throes, yearning. In particular cases it may be the desire for somebody of something specific, nostalgia, love-sickness. At the lowest level it grades into ennui, boredom.”

Perhaps, given my pockmarked history of holiday experiences, I am primed to feel the weight of toska each year. Or, perhaps this is something experienced by those who have lost a core member of the family. The holidays, for all their cheer, will always be a quiet reminder that my father is not around to throw a tantrum over tangled Christmas lights. Or maybe it is the mark of adulthood, when the magic of the morning is tempered by all the work it took to create it, and all the impending work it’s going to take to erase it.

But the stupid heart always has hope.

This year, while a campy holiday Hallmark movie chirped in the background as I loafed prone and achy on my mother’s couch, we talked about uncertainty. My illness, it seemed, was the physical manifestation of everything I don’t know going into the new year. And I don’t know anything right now.

I have had a sense, for months, that big change is coming to my world. And yet, there is no indication of what that might be or where it might take place. All I know is that in October, my income evaporated when a client’s situation changed, and since then I have watched lead after lead dry up while I anxiously monitor my bank accounts.

My heart, too, is searching for a signal, but the frequency I put out keeps getting lost in static. And yet I cannot shake the situation, the person, and how their existence in my life has fundamentally altered my perception of myself, my abilities, and what I want to experience in the world.

Meanwhile, in my Instagram DMs, a woman reached out to tell me that after 16 months of tapering, the last night of the year would also be her last time taking an SSRI. I reposted this on my Instagram stories, thrilled to get a bit of good news given that most of the messages I receive are of the opposite ilk.

The post gained attention, at soon folks were messaging me with other antidepressant withdrawal wins. One woman went to her first concert in four years, armed with earplugs to combat withdrawal-induced noise sensitivity. Another shared a story about her first trip to the grocery store after coming out of Zoloft withdrawal. Another recently gave birth to a healthy baby fourteen months after horrific Effexor withdrawal.

These little messages, most from folks who’d contacted me in the depths of suffering, lifted me not because of any hand my work may or may not have had in their healing, but because it reminded me that blind conviction is a requirement during fallow seasons. The other side of toska is hope. It is hope that lets us endure the pining, restlessness, and yearning for the magic to return, for the static to clear, and for the body to find health and equilibrium.

And so I awoke lighter this morning, the pull of toska not quite as heavy, the phlegmy cough a little less rough, with a little more patience to let the signal of work and love travel to their receivers.

Bestill the stupid, stupid heart.